Subject(s)
Anemia, Hemolytic/drug therapy , Immunosuppressive Agents/therapeutic use , Thalassemia/drug therapy , Thalidomide/therapeutic use , Aged , Anemia, Hemolytic/blood , Anemia, Hemolytic/immunology , Anemia, Hemolytic/pathology , Antibodies, Monoclonal, Murine-Derived/therapeutic use , Blood Transfusion , Female , Hemolysis/drug effects , Humans , Immunoglobulin Allotypes/blood , Immunologic Factors/therapeutic use , Middle Aged , Rituximab , Thalassemia/blood , Thalassemia/immunology , Thalassemia/pathology , Treatment OutcomeABSTRACT
Until the beginning of the current millennium, few concrete therapeutic possibilities were available for myelodysplastic syndrome (MDS) patients. This situation has dramatically changed in the last decade when new knowledge, new drugs and new opportunities have become available for physicians and their MDS patients. A correct diagnostic and prognostic assessment of all MDS patients wherever they are first seen in a hematology or internal medicine department is mandatory to identify the best therapeutic option and the most appropriate resources allocation. This article will review modern diagnostic criteria and classification together with correlated new therapeutic opportunities.
Subject(s)
Hematology/methods , Hematology/trends , Internal Medicine/methods , Internal Medicine/trends , Myelodysplastic Syndromes/diagnosis , Humans , Myelodysplastic Syndromes/epidemiology , Myelodysplastic Syndromes/therapy , Prognosis , Risk FactorsSubject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Leukemia, Monocytic, Acute/drug therapy , Leukemia, Myeloid, Acute/drug therapy , Leukemia, Myelomonocytic, Acute/drug therapy , Leukemic Infiltration/prevention & control , Meninges/pathology , Adult , Bone Marrow Transplantation , Combined Modality Therapy , Cytarabine/administration & dosage , Daunorubicin/administration & dosage , Etoposide/administration & dosage , Female , Humans , Idarubicin/administration & dosage , Injections, Spinal , Leukemia, Monocytic, Acute/pathology , Leukemia, Monocytic, Acute/surgery , Leukemia, Myeloid, Acute/pathology , Leukemia, Myelomonocytic, Acute/pathology , Leukemic Infiltration/drug therapy , Male , Middle Aged , Mitoxantrone/administration & dosage , Testis/pathology , Young AdultABSTRACT
Recently, management of limited stage diffuse large cell lymphoma (DLCL) is trending toward a low intensity chemotherapy approach. Since 1993 we have used a brief weekly (6 weeks) chemotherapy scheme (Doxorubicin, Cyclophosphamide, Bleomycin, Vincristine, and Prednisone = ACOP-B) followed by involved field radiotherapy in 207 consecutive patients with well defined localized DLCL without age limit (median 57 years, range 18-85). Treatment was completed as designed in 183 of 207 patients (88%). One hundred and ninety-nine patients (96%) achieved complete remission. At a median follow-up of 66 months 170 patients are alive (82%), 168 of them free of disease. Twenty-nine patients experienced relapse after achieving a complete remission. Kaplan-Meier, risk of relapse was 24% after 13 years. Thirty (14.5%) patients have died, 14 (6.8%) due to lymphoma progression, one due to regimen toxicity and 15 (7.2%) from other causes while remaining in complete remission. The probability of overall survival and event free survival at 13 years was 78% (95% CI 70-87%) and 63% (95% CI 50-75), respectively. Crude rate of secondary malignancy was 5.26 /1000 person-years. The ACOP-B regimen plus involved field radiotherapy is well tolerated both short and long term and is an effective chemotherapy scheme for very well defined limited stage aggressive non-Hodgkin lymphomas in all age categories.
